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General NPI Number Information
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NPI Number | 1578459483
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Entity Type | Organization
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Legal Business Name | RENEWED RESILIENCE, LLC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 7293 HANOVER GREEN DR STE 201B
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1791
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Country | US
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Telephone | 804-847-0116
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Fax | 804-847-0116
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Provider Business Mailing Address
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Address Line | 7293 HANOVER GREEN DR STE 201B
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City | MECHANICSVILLE
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State | VA
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Zip | 23111-1791
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Country | US
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Telephone | 804-847-0116
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Fax | 804-847-0116
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Authorized Official
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Title or Position | OWNER
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Name | LATARA TWANIQUE LEWIS
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Credential |
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Telephone | 804-847-0116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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